Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Bethesda Physiocare, Inc., Bethesda, MD, USA.
J Anat. 2020 Jan;236(1):3-20. doi: 10.1111/joa.13086. Epub 2019 Sep 1.
Low back pain is a major health issue affecting the lumbopelvic muscles. Morphological changes in hip muscles, such as alterations in the muscle cross-sectional area and muscle volume, may occur in patients with low back pain. This systematic review was conducted to investigate whether patients with low back pain have macroscopic changes in their hip muscle morphology compared with asymptomatic, healthy individuals, based on current evidence. The electronic databases of PubMed/Medline, Ovid, Scopus, Embase , and Google Scholar were searched from the inception to August 31, 2018. We only included full texts of original studies regarding macroscopic morphological alterations, including atrophy and fat infiltration, in hip muscles of patients with low back pain compared with asymptomatic controls. The quality of the included studies was determined using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study. Sixteen comparative observational studies were found eligible to be included in this review. Eleven were classified as high quality and four as moderate quality. The morphological changes in the psoas major, gluteus maximus, gluteus medius, gluteus minimus, and piriformis muscles were assessed in the primary studies. All selected studies were considered B level of evidence studies. The strength of conclusions for the psoas major, gluteal, and piriformis muscles was moderate. The results revealed that there is substantial controversy about the morphological changes in hip muscles in patients with low back pain; however, the majority of high-quality studies concluded that atrophy of hip muscles is evident in patients with low back pain. The psoas major muscle was the most commonly investigated hip muscle for morphological changes. Major methodological limitations of the included studies were identified and discussed. The present systematic review does not include a formal meta-analysis because of very significant differences in the primary studies in terms of study populations and methodologies. Finally, in clinical practice, it is recommended that physical therapists develop exercise programs to improve hip muscle function in patients with low back pain.
下背痛是影响腰骶部肌肉的一个主要健康问题。患有下背痛的患者可能会出现髋关节肌肉形态的变化，如肌肉横截面积和肌肉体积的改变。本系统评价旨在根据现有证据，调查患有下背痛的患者与无症状健康个体相比，其髋关节肌肉形态是否存在宏观变化。从 2018 年 8 月 31 日起，我们检索了 PubMed/Medline、Ovid、Scopus、Embase 和 Google Scholar 电子数据库。我们仅纳入了关于患有下背痛的患者与无症状对照组相比髋关节肌肉形态的宏观变化（包括萎缩和脂肪浸润）的原始研究的全文。使用基于纽卡斯尔-渥太华量表的评估工具来确定纳入研究的质量。该量表针对本研究进行了修改。共发现 16 项符合纳入标准的观察性比较研究。其中 11 项被归类为高质量，4 项为中等质量。主要研究评估了腰大肌、臀大肌、臀中肌、臀小肌和梨状肌的形态变化。所有选定的研究都被认为是 B 级证据研究。对于腰大肌、臀肌和梨状肌的结论的可信度为中等。结果表明，对于患有下背痛的患者髋关节肌肉形态的变化存在很大争议；然而，大多数高质量研究得出的结论是，患有下背痛的患者髋关节肌肉萎缩明显。腰大肌是最常被研究的髋关节肌肉形态变化。纳入研究的主要方法学局限性已被确定并进行了讨论。由于初级研究在研究人群和方法学方面存在很大差异，本系统评价未进行正式的荟萃分析。最后，在临床实践中，建议物理治疗师制定运动方案来改善患有下背痛的患者的髋关节肌肉功能。
